Home

Pflogging

the never-ending quest for pragmatic solutions, useful plans, flawless execution, and designs that endure
Home Book quotes

User login

  • Create new account
  • Request new password

A number of key features are only available to registered users. They include:

  • Access to the full content of top-rated material (only teasers are available to anonymous users after the material has been posted for 45 days)
  • The ability to search site content
  • The ability to access reviews of books relevant to site material
  • The ability to access key quotes relevant to site material
  • The ability to access content from partner sites
  • The ability to rate material
  • The ability to post comments
  • The ability to post new information and propose it for publication
  • The ability to request email notification when selected content is added or updated

Checklist manifesto

Checklist manifesto

Managing complexity

Under conditions of true complexity - where the knowledge required exceeds that of any individual and unpredictability reigns - efforts to dictate every step from the center will fail. People need room to act and adapt. Yet they cannot succeed as isolated individuals, either - that is anarchy. Instead, they require a seemingly contradictory mix of freedom and expectation - expectation to coordinate, for example, and also to measure progress.

Checklists... made the reliable management of complexity a routine. That routine requires balancing a number of virtues: freedom and discipline, craft and protocol, specialized ability and group collaboration. And for checklists to help achieve that balance, they have to take two almost opposing forms. They supply a set of checks to ensure the stupid but critical stuff is not overlooked, and they supply another set of checks to ensure people talk and coordinate and accept responsibility while nonetheless being left the power to manage the nuances and unpredictability the best they know how.

The genesis of checklists

Still, the army purchased a few aircraft from Boeing as test planes, and some insiders remained convinced that the aircraft was flyable. So a group of test pilots got together and considered what to do. What they decided not to do was almost as interesting as what they actually did. They did not require Model 299 pilots to undergo longer training. It was hard to imagine having more experience and expertise than Major Hill, who had been the air corps' chief of flight testing. Instead, they came up with an ingeniously simple approach: they created a pilot's checklist. Its mere existence indicated how far aeronautics had advanced.

Read more »

Professionalism

We don't like checklists. They can be painstaking. They're not much fun. But I don't think the issue here is mere laziness. There's something deeper, more visceral going on when people walk away not only from saving lives but from making money. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists.

The fear people have about the idea of adherence to protocol is rigidity. They imagine mindless automatons, heads down in a checklist, incapable of looking out their windshield and coping with the real world in front of them. But what you find, when a checklist is well made, is exactly the opposite. The checklist gets the dumb stuff out of the way, the routines your brain shouldn't have to occupy itself with.

—

Atul Gawande

Read more »

Territoriality

 

We doctors remain a long way from actually embracing the idea. The checklist has arrived in our operating rooms mostly from the outside in and from the top down. It has come from finger-wagging health officials, who are regarded by surgeons as more or less the enemy, or from jug-eared hospital safety officers, who are about as beloved as the playground safety patrol. Sometimes it is the chief of surgery who brings it in, which means we complain under our breath rather than raise a holy tirade. But it is regarded as an irritation, as interference on our terrain. This is my patient. This is my operating room. And the way I carry out an operation is my business and my responsibility. So who do these people think they are, telling me what to do? 

 

—

Atul Gawande

Checklists under pressure

There are good checklists and bad, Boorman explained. Bad checklists are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb and try to spell out every single step. They turn people's brains off rather than turn them on.

Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything - a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps - the ones that even the highly skilled professionals using them could miss.

Good checklists are, above all, practical. The power of checklists is limited, Boorman emphasized. They can help experts remember how to manage a complex process or configure a complex machine. They can make priorities clearer and prompt people to function better as a team. By themselves, however, checklists cannot make anyone follow them.

Read more »
  • 1
  • 2
  • next ›
  • last »